Gender-Affirming Care Letters for Adults
Are you over the age of 18 and looking for a mental health provider to write a letter for gender-affirming surgery? I am trained in evaluating and assessing adults for this purpose. In just one 90-minute session with me and a consultation with your individual therapist, I provide letters within two weeks. Current clients of Queer AF Therapy do not need to pay the fee for a support letter.
I provide letters using the WPATH guidelines (see below), which most surgery centers and medical providers accept. Often, the following is needed for certain types of gender-affirming care, but not all surgery centers require them:
Hormone Replacement Therapies (HRT) sometimes require one letter from a licensed mental health specialist. Many medical providers do not require a letter.
Top surgeries may require one letter from a licensed mental health specialist (LCSW, MFT, LMFT, CSW, Ph.D., Psy.D.,) and one medical health professional (M.D. or D.O.). Some surgeries also request a separate referral letter from your medical health provider, which is different from the support letter.
Bottom surgeries may require three letters; two from two different licensed mental health specialists (with a high recommendation that one letter be from a provider with a doctorate), and one letter from an M.D. or D.O acting as your hormone provider. If your hormone provider is also your mental health provider, they will need to write two separate letters to meet the requirements. Some surgeries also request a separate referral letter from your medical health provider, which is different from the support letter.
Revision surgeries often require an updated letter if you no longer have the same have changed your legal name, your past surgery was not performed at the same surgery center, and/or you have a different insurance provider or policy.
I am able to provide only the support letter from a mental health specialist with a Master’s Level degree who is unable to prescribe HRT, and not any of the other letters. Please note that the State of Texas does not currently allow gender-affirming care for minors and I am unable to provide support letters for this purpose.
Why do I Need a Support Letter?
Insurance companies often require a support letter from a mental health specialist prior to all gender affirming surgeries and occasionally, before starting hormone therapy. The letter is a statement that you are ready and able to give informed consent to receiving the procedures. A support letter also communicates to the surgery center, medical professional, and the insurance company that a qualified mental health clinician has evaluated your gender history, assessed for co-occurring mental health conditions, and concluded that your requested surgery is consistent with your integrated mental health. A support letter may substantially reduce the likelihood that an insurance company will deny your surgery before the authorization process even begins.
Depending on your region in the U.S., some professionals gate-keep gender-affirming care support letters and ask you to jump through a lot of hoops. I follow your lead, and discuss your lived experiences with you in a non-pathologizing way so we may streamline the assessment and evaluation process and get you the life-saving care you need to feel your best self.
The Process
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Double-check to see if your medical provider accepts a support letter from a mental health professional at a Master’s level with a diagnosis of Gender Dysphoria. Not all medical providers require this.
Double-check what letter guidelines or templates your surgery center requires (i.e. WPATH)
Contact me to set up a 90-minute Assessment + Evaluation Session
Once booked, I will send you a form to complete with relevant information and charge you the fee (either the full fee of $250 or a sliding scale fee we have agreed upon)
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In our Assessment + Evaluation session, we will discuss the following:
Key moments in your gender history
Co-occurring mental health conditions
Logistics fulfilling the WPATH (see below) or your surgery center’s specific guidelines for the support letter
How you and your community have prepared for your surgeries and the support you will need after your surgeries
Any other questions or concerns you or I may have
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In the consultation with your current individual therapist, I will discuss:
Co-occurring mental health conditions
Key moments in your therapeutic work together
How you and your therapist have prepared for the surgeries and the post-op mental health plan and support your therapist will provide
Any other questions or concerns I or your therapist may have
If you do not currently have an individual therapist, I require at least a month of weekly 50-minute therapy sessions for an assessment period. My typical full and sliding scale fees apply.
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I will send the letter to you via email attachment within two weeks from either our session date or my consultation with your therapist, whichever happens last.
You may follow-up with me about the letter if you have any questions, changes your want to make, or concerns.
WPATH Guidelines
The World Professional Association for Transgender Health (WPATH) sets the tone for standardized care in working with transgender humans in both the medical and mental health fields. I predominantly ascribe to their most recent Standards of Care guidelines version 8, released in 2022, when writing a gender-affirming care letter.
Their guidelines include but are not limited to the following:
The exact list of gender-affirming surgeries you will be receiving (e.g., phalloplasty, vaginoplasty, metoidioplasty, top surgery, chest masculinization, breast augmentation, orchiectomy)
Confirmation of the presence of a Gender Dysphoria diagnosis, which I assess in a non-pathologizing way
Confirmation of your ability to comply with long-term follow-up and post-operative expectations
Confirmation that you experienced no coercion from external parties and that you provided informed consent to move forward with the surgery
Confirmation that you are informed on the irreversible nature associated with the surgical procedure, including potential fertility issues in the case of Bottom Surgeries
Confirmation that your current therapist is available for coordination of care and continued mental health support (if you do not have an individual therapist and I have openings, I may also able to provide you with ongoing post-operative therapy services)
IF YOU ARE CURRENTLY RECEIVING HORMONE THERAPY – Most insurance companies will want information on whether you are taking hormones and if you are not, a statement of why that is. This is not required by all insurances and surgery centers, but it is important information to include.
